Comments on: How should doctors handle the difficult patient?

By: patient health records storage

patient health records storage — Wed, 14 Oct 2009 11:24:14 +0000

How should doctors handle the difficult patient?
First the doctor and the patient relationship has to be re-defined, the truth is that the doctors are service-providers and patients the customers, it is a commercial tie-up between a doctor and a patient. The doctor is not going to provide his services to a patient without receiving his fees. Similarly, a patient will not use the services of a doctor who fires his patients, instead will look for a health care provider that do not fire their customers.

By: AnonymousQ

AnonymousQ — Tue, 06 Oct 2009 18:33:58 +0000

Nuclear, since discussion has tapered off, I feel confident that my point in full will not distract from “what do do with a patient you have already decided you don’t want anymore”.

I think it’s relevent. I think many physicians take the disturbed affect of their patients personally, when disease is actually changing the way the patient interacts with the world.

If you have not yet diagnosed parkinsons, will you notice the tell tale personality changes? Cumulative damage from diabetes or poorly controlled blood sugar can result in personality changes, as can thyroid disease, complications of liver disease, other endocrine disease – a host of common problems. Even chronic pain has been determined to cause changes to brain, and therefore personality.

Why did you distinguish bi-polar disorder as “non-organic”? It have an organic cause, and a chemical treatment.

It makes me suspect that the affect of the patient due to disease may be assumed to be something under the patient’s control, with the patient blamed for non-conforming behaviour and removed from the physicians care, when it is directly related to a need for medical management.

By: Heart Patient

Heart Patient — Tue, 06 Oct 2009 15:56:21 +0000

In response to “customer of heathcare”, “As well, the term patient is actually offensive in this day and age.”:

I don’t find the term Patient offsensive at all. I’ve worked in health care finance 30+ years, and our hospital system staff was trained to refer to the “patients” as “customers”. I find that demeaning myself. I AM a Patient. To me a “customer” is a person that shops in a retail environment, etc. I have a very special relationship with my physicians; and they certainly don’t treat their patients with the lack of care that “customers” seem to receive.

By: Paul MD

Paul MD — Mon, 05 Oct 2009 19:07:03 +0000

#1 “At first he called me an incompetent boob”
#2 “Ouch!”
#1 “Then he threatened to sue me and harm me and my family”
#2 “You’re kidding?”
#1 “Then he DID sue me”
#2 “For real?”
#1 “Yeah”
#2 “What are you going to do now?”
#1 “At first I was angry, then depressed and well, you know all of the stages….”
#2 “What ever happened to him?”
#1 “Oh…I’m still seeing him as a patient”
#2 “Tell me you’re kidding”
#1 “No, not at all. I found out that he was just being truculent”
#2 “Ohhhh….”

By: Nuclear Fire

Nuclear Fire — Mon, 05 Oct 2009 17:35:18 +0000

@AnonymousQ
I believe your argument is not addressing the issue of this post and is quite unfortunately hindering the dialogue.

Specifically, the author is talking about “the medical community [talking] formally about “The Difficult Patient”. This formally defined patient is specifically not someone whose behavior is disruptive due to underlying organic disease such as stroke, Alzhiemer’s etc. or non-organic illness such as Bipolar, ADHD etc. Obviously (I would hope), this is not what we mean by disruptive or abusive patients but rather those without underlying pathology. Thank you for reminding us that some diseases can alter behavior and personalities. I accept your point as well taken, but do not think it germane to the specified topic.

By: AnonymousQ

AnonymousQ — Mon, 05 Oct 2009 16:57:41 +0000

If You reduce the patient’s affect to “psychosocial” factors, you may be misinterpreting a sign of illness.

By: AnonymousQ

AnonymousQ — Mon, 05 Oct 2009 16:53:45 +0000

Nuclear, but truculence and stubborness and lack of internal “screening” of impulses is a feature of many diseases. It’s wonderful to have nice healthy patients who are never cross or impatient…but the ill ones are the ones that need care the most.

By: Evinx

Evinx — Mon, 05 Oct 2009 16:44:50 +0000

Never been fired by a dr but know 2 who have. In both cases, it had nothing to do with abusive behavior, or chronic lateness, etc. It had to do with questioning the dr. Too many (not all) are on their 6 minute/patient schedule and really dislike patients who ask lots of questions. And the dirty little secret is if you question about type of testing and if really necessary, many drs feel threatened and vulnerable. Let’s be honest – many times there are referrals involved for testing, + these referrals translate to favors, dinners + drinks, and cross-referrals. So if you continually question against tests that are “routine” (and not for any symptom), drs get upset. You are taking too much of their time and perceived as the type who may cause legal trouble. The most effiicent patient from a dr’s view, is the one who is relatively compliant and does not question anything – the patient-automoton. Break out of the automoton mode and you risk getting fired.

Of course, this is not all cases but with the tremendous fear of litigation, it is becoming an increasing by-product of the lack of some kind of tort reform.

By: Paul MD

Paul MD — Mon, 05 Oct 2009 15:33:17 +0000

Nuclear Fire,
Well put. Thank you. The “biopsychosocial model” has no provisions for people being as%ho@es whether they are the caregiver or the patient.

By: Overworked/underpaid MD

Overworked/underpaid MD — Mon, 05 Oct 2009 15:12:59 +0000

Easy question to answer: Fire first, ask questions later.